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Fuchs’ dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty?
Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?
P. Rodriguez-Ausin
, D. Antolin-Garcia, L. Santamaria Garcia, A.-B. Blazquez-Fernandez
Corresponding author
Hospital Universitario de Torrejón de Ardoz, Torrejón de Ardoz, Madrid, Spain
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "237" "paginaFinal" => "240" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 595 "Ancho" => 1346 "Tamanyo" => 87511 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BMC 2012: queratotomía radial, edema central y catarata senil. 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Ruiz-Rizaldos, J. Baviera-Sabater, J. Ortega-Usobiaga" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A.I." "apellidos" => "Ruiz-Rizaldos" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Baviera-Sabater" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Ortega-Usobiaga" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300610?idApp=UINPBA00004N" "url" => "/21735794/0000009200000005/v1_201704260025/S2173579417300610/v1_201704260025/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Fuchs’ dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "237" "paginaFinal" => "240" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Rodriguez-Ausin, D. Antolin-Garcia, L. Santamaria Garcia, A.-B. Blazquez-Fernandez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Rodriguez-Ausin" "email" => array:2 [ 0 => "pazrausin@telefonica.net" 1 => "prodriguez@torrejonsalud.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Antolin-Garcia" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Santamaria Garcia" ] 3 => array:2 [ "nombre" => "A.-B." "apellidos" => "Blazquez-Fernandez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario de Torrejón de Ardoz, Torrejón de Ardoz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2250 "Ancho" => 2927 "Tamanyo" => 1497676 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pentacam<span class="elsevierStyleSup">®</span> 2013 RE (A), LE (B) and 2016 RE (C), LE (D). Oblate pattern with slight the centering in BE and increased pachymetry, 2013. In 2016, central pachymetry diminished 197<span class="elsevierStyleHsp" style=""></span>μm in BE producing changes in pattern arrangement, but K values and astigmatism remained similar (Mean K, RE: 2013 38.8<span class="elsevierStyleHsp" style=""></span>D/2016 38<span class="elsevierStyleHsp" style=""></span>D; LE: 2013 35.7<span class="elsevierStyleHsp" style=""></span>D/2016 36.6<span class="elsevierStyleHsp" style=""></span>D). Anterior and posterior surface are elevated due to the RK configuration, not to ectasia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Radial keratotomy (RK) is a refractive cornea procedure that was last applied in the late 1990s and consisted in deep radial incisions in the corneal stroma to flatten the central cornea and diminish its dioptric power. The case of a patient is presented that exhibits the coexistence of RK, endothelial dysfunction and cataracts in both eyes (BE).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male, 70, who visited the practice in 2012. He had undergone surgery 28 years before (1989) with RK (RE: −4 diopters with 4 incisions; LE: −6 diopters with 6 incisions) and referred satisfactory vision up to 10 years ago. Corneal thickening could be observed with brushed metal appearance of the endothelium and nucleocortical cataract in BE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Baseline best corrected visual acuity was 0.2 RE (+0.75 –0.50<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>103) and 0.1 LE (+2.50 –1.50<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100). In Visante-Omni<span class="elsevierStyleSup">®</span> (Carl Zeiss Meditec, Jena, Germany) and Pentacam<span class="elsevierStyleSup">®</span> (Oculus, Wetzlar, Germany) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B), oblata cornea was observed with diffuse thickening due to edema, with anterior and posterior surfaces matching the usual RK profile and without ectasia data in wavefront in 2012.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the progressive worsening of the condition, the authors discussed with the patient the advantages and drawbacks of penetrating versus lamellar procedure and opted for Descemet stripping automatized endothelial keratoplasty (DSAEK) with prior lens surgery, warning the patient about possible refractive surprises. The lens was calculated in agreement between IOLmaster<span class="elsevierStyleSup">®</span> (Carl Zeiss Meditec, Jena, Germany) and ASCRS Calculator on the basis of baseline topographic data and the data obtained in the baseline 4<span class="elsevierStyleHsp" style=""></span>mm data of Pentacam<span class="elsevierStyleSup">®</span>. Phacoemulsification was performed with hydrophobic lens (RE 26<span class="elsevierStyleHsp" style=""></span>D and LE 24.5<span class="elsevierStyleHsp" style=""></span>D Alcon SN60WF) and −1.50<span class="elsevierStyleHsp" style=""></span>D objective (offsetting post-DSAEK hypermetropia), and performing 4 months later DSAEK, LE in 2014 and RE in 2015, with precut lamella from the eye bank. The button implant was made with a Busin slider in a 4<span class="elsevierStyleHsp" style=""></span>mm incision. No complications arose in relation to the radial keratotomies.</p><p id="par0020" class="elsevierStylePara elsevierViewall">AFter DSAEK, the cornea exhibited a temporary flattening with diminished pachymetry and without significant final curvature and aberration changes against preop values (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a><span class="elsevierStyleSmallCaps">C</span> and D). The only complication was a recurrent cystoid macular edema, with final uncorrected visual acuity being 0.3 in BE and best corrected visual acuity 0.50 in BE, with spherical equivalent of +0.50 in RE and +1 in LE, stable as of month 6 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients who underwent RK frequently exhibit fluctuating visual acuity and refraction, although endothelial damage after RK is infrequently described, to the point that some operated corneae were apt as endothelium donors.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> On the other hand, Moshirfar et al. reported 13 eyes of 7 patients with late endothelial dysfunction after RK which they postulated as being directly related to surgery because a patient with unilateral surgery had a healthy endothelium in the eye that was not intervened.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Biomicroscopy of the present patient suggested belated Fuchs dystrophy,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> as his 14-year-old son exhibited signs of the same disorder.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In what concerns the technique to be chosen, penetrating keratoplasty seemed to be the best option in the presence of altered stroma and endothelium. Diminished vision 10 years ago was explained by the corneal edema and cataracts. The vulnerability of 360° perforating incisions, sutures and slow visual recovery must be pondered against a small incision and the rapid recovery of endothelial transplant. DSAEK in RK cases have been reported with good results in the absence of ectasia in stromal fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,5</span></a> The authors considered two options: a triple procedure with penetrating keratoplasty or DSAEK, or sequential surgery. The former option involved a simple calculation of the intraocular lens, but a long time would have to elapse before the second surgery. If cataract surgery was performed first, followed by DSAEK in the short-term, the recovery would be faster but the calculation of the intraocular lens would be complicated by the usual fluctuation of data after RK. In addition, nowadays it is known that other factors are involved. As indicated by Camelin et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> contrary to what was previously accepted, a significant flattening of the posterior face vis-à-vis the anterior face occurs after RK. In 2005, in a review of biometry after RK, Geggel<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> concluded that the simplest calculation method was the Haigis in IOLmaster with a −1<span class="elsevierStyleHsp" style=""></span>D lens. The slightly positive refractive result obtained by the authors could have been improved adding said lens to the −1.50<span class="elsevierStyleHsp" style=""></span>D lens utilized in DSAEK.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient expressed his satisfaction with the result. The incidence of cystoid macular edema after endothelial transplant ranges between 4% for DSAEK and 8% for Descemet membrane endothelial keratoplasty<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> and was the only relevant complication.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, the coexistence of Fuchs dystrophy and RK is unusual and susceptible to various surgical options. DSAEK preceded by phacoemulsification<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>intraocular lens could be an option for selected cases when the presence of a topography with a certain stability and the absence of stromal fibrosis has been verified.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres833054" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec828976" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres833053" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec828977" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-16" "fechaAceptado" => "2016-10-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec828976" "palabras" => array:5 [ 0 => "Radial keratotomy" 1 => "Descemet stripping automated endothelial keratoplasty" 2 => "Fuchs corneal dystrophy" 3 => "Endothelial dysfunction" 4 => "Corneal edema" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec828977" "palabras" => array:5 [ 0 => "Queratotomía radial" 1 => "Queratoplastia endotelial automatizada con pelado de la Descemet" 2 => "Distrofia corneal de Fuchs" 3 => "Disfunción endotelial" 4 => "Edema corneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs’ dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular edema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Paciente de 70 años que acude con queratotomía radial, signos de distrofia de Fuchs con edema central y catarata. Se realiza cirugía en 2 tiempos: facoemulsificación e implante de lente intraocular y 4 meses después DSAEK <span class="elsevierStyleItalic">(descemet stripping automatized endothelial keratoplasty)</span> en ambos ojos sucesivamente sin complicaciones, salvo edema macular cistoide recurrente en ambos ojos. La agudeza visual corregida final es 20/40 en ambos ojos y el paciente se encuentra satisfecho.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ante coexistencia de queratotomía radial y disfunción endotelial, la DSAEK constituye una alternativa a la queratoplastia penetrante si no se detecta ectasia corneal ni opacidad estromal significativa.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodriguez-Ausin P, Antolin-Garcia D, Santamaria Garcia L, Blazquez-Fernandez AB. Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar? Arch Soc Esp Oftalmol. 2017;92:237–240.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 595 "Ancho" => 1346 "Tamanyo" => 94579 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BMC 2012: radial keratotomy, central edema and senile cataracts. In RE, 4 incisions for −4 sph. (A) and in LE 6 incisions for −6 sph. (B) Pachymetry 620<span class="elsevierStyleHsp" style=""></span>μm RE, 650<span class="elsevierStyleHsp" style=""></span>μm LE.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2250 "Ancho" => 2927 "Tamanyo" => 1497676 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pentacam<span class="elsevierStyleSup">®</span> 2013 RE (A), LE (B) and 2016 RE (C), LE (D). Oblate pattern with slight the centering in BE and increased pachymetry, 2013. In 2016, central pachymetry diminished 197<span class="elsevierStyleHsp" style=""></span>μm in BE producing changes in pattern arrangement, but K values and astigmatism remained similar (Mean K, RE: 2013 38.8<span class="elsevierStyleHsp" style=""></span>D/2016 38<span class="elsevierStyleHsp" style=""></span>D; LE: 2013 35.7<span class="elsevierStyleHsp" style=""></span>D/2016 36.6<span class="elsevierStyleHsp" style=""></span>D). Anterior and posterior surface are elevated due to the RK configuration, not to ectasia.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 850 "Ancho" => 1231 "Tamanyo" => 160414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy after DSAEK, transparent button in BE (A and B). Pseudophakic. Visante High res corneal (flap-tool) one month after DSAEK, lamella thickness 74<span class="elsevierStyleHsp" style=""></span>μm RE (C) and LE 60<span class="elsevierStyleHsp" style=""></span>μm (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effects of radial keratotomy on the corneal endothelium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. MacRae" 1 => "L.F. 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